=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346117694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELTA SPECIALTY PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2025
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 MAGNOLIA AVE STE 205
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-281-2730
-----------------------------------------------------
Fax | 951-281-2731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 MAGNOLIA AVE STE 205
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-281-2730
-----------------------------------------------------
Fax | 951-281-2731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GARVIN PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 951-281-2730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------